Emflaza — CareFirst (Caremark)
Duchenne muscular dystrophy (DMD)
Preferred products
- deflazacort (generic)
Initial criteria
- Prescribed by or in consultation with a physician who specializes in the treatment of Duchenne muscular dystrophy (DMD)
- Diagnosis of DMD confirmed by genetic testing demonstrating a mutation in the DMD gene OR muscle biopsy demonstrating absent dystrophin
- Member age ≥ 2 years
- Member has tried prednisone or prednisolone and experienced unmanageable and clinically significant weight gain/obesity or psychiatric/behavioral issues (e.g., abnormal behavior, aggression, irritability)
- For weight gain/obesity criterion: body mass index is in the overweight or obese category while receiving treatment with prednisone or prednisolone
Reauthorization criteria
- Member meets all requirements in the coverage criteria section
- Member is receiving a clinical benefit from therapy with the requested medication (e.g., improvement or stabilization of muscle strength or pulmonary function)
Approval duration
Initial: 6 months; Continuation: 12 months